Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9154
Peer-review started: June 4, 2016
First decision: July 12, 2016
Revised: July 26, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: November 7, 2016
To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes.
A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox regression.
One hundred and ninety-three patients received a local donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase (mean: 45 U/L vs 84 U/L, P = 0.035), higher donor risk index (mean: 1.88 vs 1.42, P < 0.001) and longer cold ischemic time (CIT) (mean: 10.1 h vs 6.4 h, P < 0.001). There was a weak correlation between CIT and transport distance (r2 = 0.29, P < 0.001). Mean follow up was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss (HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver (P = 0.027).
Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.
Core tip: This study demonstrated a significantly decreased graft and patient survival for patients who received an airplane transported donor liver compared to a local donor liver not requiring airplane transport. The hazard ratio for airplane transported donor livers compared to local donor livers was 1.98 for graft survival and 1.86 for patient survival. The effect of airplane transportation was independent of cold ischemic time.